1. Field of the Invention
The present invention relates to a software based method and system for tracking and supporting compliance with a management scheme for individualized educational instruction, behavioral interventions or social interventions, and in particular to a software based method and system for tracking of, supporting compliance with, and otherwise assisting in determining whether an individual has received required services, analyzing service gaps, and using data provided in such determinations to assist in obtaining Medicaid or other reimbursements.
2. Background of the Technology
There is an unmet need in the art for methods and systems for the tracking of, supporting compliance with, and otherwise providing assistance in meeting requirements for the complex and sophisticated management schemes that institutions need to use in order to effectively and efficiently manage mandated individualized instructional paths, disciplinary/rehabilitative paths, or social intervention paths for hundreds if not thousands of students, juveniles, etc., simultaneously, all with different start and end dates, and different internal individualized management steps. For example, looking at mandated individualized instructional paths, it is not uncommon to find that a U.S. public K-12 school district may need to manage 30% or more of its student population under individualized instructional programs such as Special Education, 504, English Second Language, Early Intervention/Student Support Team, Gifted and Talented, or At Risk of Failing High Stakes Exit Exams. Each of these programs includes requirements involving events or meetings (such as Referrals, or Annual Meetings or Reevaluation Meetings), associated timeliness linked paperwork, and mandated outcomes.
Successful, consistent, legally compliant execution of these individualized programs by a school district requires the tight coordination of dozens of action steps across multiple team members for each affected child within relatively short time periods. Failure to effectively manage, what in many school districts may be thousands of individualized instructional paths going on simultaneously, significantly diminishes the education effectiveness of these interventions, exposes the district to serious legal liability for violating Federal and State law, risks loss of full Federal and State funding, and drives up a district's administrative overhead.
An individualized education plan (IEP), as required by the Individuals with Disabilites Education Act (IDEA), specifies services to be provided to children with disabilities. School districts or other entities responsible for carrying out the provisions of the IDEA must ensure that the services specified are actually provided, both for liability reasons under the Act and to obtain reimbursements, as appropriate, such as from Medicaid. However, determining the services actually provided by the provider is difficult for several reasons.
First, many problems can arise in determining the actual number of services that should be provided in a given time frame, and existing systems for supporting IDEA activities typically do not adequately address this issue. For example, the frequency of services is often designated on a monthly or weekly basis. However, these frequency designations often cause inconsistencies and confusion, for example, due to anomalies in calendar periods (e.g., determining how many weekly services are to be delivered in a month when a month has four weeks and one day; accounting for vacations, holidays, and other absences) and/or difficulties in calendars across a school system (e.g., reconciling services to be delivered following a child's move from one building operating on a school year calendar to another building operating on an annual calendar).
Yet another problem with prior art systems is that these systems typically track only positive encounters (i.e., service encounters that actually occur). This approach fails to allow the service provider to account fully for the service provider's efforts, however, since it fails to account for attempts to provide services for a child. It is important to account for the fact that the school district or other entity's legal obligation to provide services for the child may be met by making the service available for the child at a specified time and place, even though the child may fail to appear and receive that service.
For example, if a service provider is to provide two therapy encounters or sessions to a child each week, and a four week period is tracked, eight therapy sessions over the time period will be received. To identify any gaps in service actually provided, this theoretical eight sessions must be compared to the sum of both actual sessions provided and attempts to provide services. Thus, if six sessions are actually provided, and the provider attempted to provide services on one occasion, the actual gap in services should be one session. There is a need for a system that appropriately accounts for service attempts.
There is a further need for a system that accounts for responsibility identification. For example, if a child moves from building A to building B on a particular date, a service provider at building A may no longer be responsible for providing the service, yet be unaware of the move to the new building; similarly, a new service provider at building B may now be responsible for that child, but be unaware that the child is now present in building B and, likewise, unaware of the new responsibility.
In particular, existing IEP tracking systems typically track who the provider is for each child, but when a change in services occurs, the previous provider is simply overwritten. Further, no start or end date is typically tracked by provider. As a result, no audit trail or other appropriate accountability can be established with the existing systems.
With regard to reimbursement, currently, Medicaid recovery for IDEA services is obtained in one of two ways: 1) primarily, recovery occurs via paper-based submission for services (e.g., blank forms or forms with only the child's name are forwarded to individual providers to complete); or 2) electronic versions of the paper-based recovery system are used (e.g., “palm-pilot” based versions of paper systems). One key problem is lack of accountability: at any given time, school districts or other entities are not able to determine what providers have submitted documents for Medicaid recovery.
As a result, low recovery of Medicaid cost reimbursement occurs with the prior art for most districts or other entities. In general, this low recovery can be tracked to two key factors: 1) underreporting (e.g., service provider forgets to report, although the service has been provided); if the district or other entity is paper-based or semi-automated, it will never know that the event has occurred and has not been reported; every event of underreporting costs the district or other entity Medicaid cost reimbursement; and 2) underservicing (e.g., service provider should have seen child, but failed—for example, service provider sick; child changed buildings, and service provider was not told; service provider simply won't see child); underservicing costs the district or other entity Medicaid cost reimbursement, and also creates a severe liability for the district or other entity under state and/or federal law to provide compensatory damages for the child. The core issue for underreporting and underservicing is accountability. The district or other entity needs to know how many services a service provider provided or should have provided to each child.
There remains an unmet need for methods and systems that account for and assist with determining gaps in services required to be provided, such as services under the IDEA, and to assist with reimbursement of these services.